New health care groups look to cut costs and improve quality

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Across the country, doctors, hospitals and insurers are forming new health care entities to increase the efficiency and quality of health care, and lower the cost of it. Called accountable care organizations, these groups are gaining ground, even though critics consider them a repackaging of HMOs some of which have given managed care a bad name.

An ACO is a group of health care providers such as doctors, hospitals and others, including insurance companies, who agree to work together to provide overall care to their patients. Those providers are accountable for the quality and cost of that care. If they reduce costs while improving patient care, they share in the savings. If they dont deliver, they may risk losing money.

While the idea has many proponents, critics are concerned about the creation of large health care groups that could have too much influence over physician decisions. That could backfire and ultimately result in increased health care costs.

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Hospitals controlling and running ACOs that makes our members very nervous, said Francisco Silva, vice president and general counsel for the California Medical Association based in Sacramento.Its absolutely important that ACOs are physician led. The ACO model can be a very good thing, but it needs to be done carefully as a collaborative effort, he said. We learned from the HMO experience. There were a lot of stories of folks being denied care.

But there is increasing support for changing the way health care is delivered and making all parties in the system accountable for the cost.

Right now Id say there is a growing consensus that accountable care is the future of health care, said David Muhlestein, an analyst with Leavitt Partners, a Salt Lake City-based health care analyst firm.

But a clear definition an ACO has yet to be determined, he added.

Affordable care organizations are emerging both through Medicare and in the private sector. The Affordable Care Act required the Centers for Medicare and Medicaid Services to develop an ACO program, which, as of July 9, has 154 ACOs serving 2.4 million Medicare patients, according to the Department of Health and Human Services. These ACOs must meet patient care standards based on 33 quality measures.

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New health care groups look to cut costs and improve quality

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